Highlights of WONCA Europe 2023
Authors: Philippa K Harris
Journal: The Lancet Healthy Longevity (2023)

The importance of primary care to healthy longevity was highlighted at the 28th World Organization of Family Doctors (WONCA) Europe 2023 conference in Brussels, Belgium (June 7–10, 2023). The importance of clinical research in primary care was highlighted in a number of talks. Alma van de Pol (Utrecht University, Netherlands; ID 568) presented the ImpresU trial, a cluster randomised trial assessing an antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults. Participants in the intervention group received 0·27 antibiotic prescriptions per person-year versus 0·58 in the usual care group. The intervention appeared safe with no differences between the groups for incidence of complications, hospital referrals, admissions to hospital, and mortality within 21 days after suspected urinary tract infection. Although the numbers in the sub-group analyses were too small to draw strong conclusions, participants with dementia, in whom diagnosing urinary tract infections can be particularly challenging, saw a larger intervention effect than those without dementia. Following on from Chris Butler's (University of Oxford, UK; KL-02) keynote lecture on the PANORAMIC trial, Philip Evans (University of Exeter, UK; ID 553) discussed the innovative methods used to recruit participants. The trial, investigating early treatments for COVID-19 in the community, recruited over 26 000 participants using a wide range of methods including the study site website and general practitioners (GPs). To date, PANORAMIC has shown that molnupiravir does not reduce the frequency of COVID-19-associated hospitalisations or death among high-risk vaccinated adults in the community. Clinical decision-making tools for use in frail older adults, developed using datasets from electronic health records, was the subject of a number of talks. Jet Klunder (Amsterdam UMC, Netherlands; ID 112) presented a clinical decision rule to predict unplanned hospital admissions in older adults. The model used data from 243 055 individuals aged 65 years or older from 417 general practices and found that 7·6% of older adults had at least one unplanned hospitalisation within a 6 month period. The model performed reasonably well at identifying those with an unplanned hospital admission (area under the curve [AUC] 0·73, 95% CI 0·72–0·73). Predicting factors that might lead to unplanned hospitalisations was also the subject of a talk by Charlotte Havreng-Théry (Presage Care, France; ID 677). Her model, developed with data from 1072 participants from 23 facilities, predicted factors such as falls, undernutrition, and depression risk with the aim of allowing GPs to intervene earlier to prevent unplanned hospital admissions (AUC 0·809, 95% CI 0·70–0·90). Marie Carrein (University of Ghent, Belgium; ID 844) presented a tool to prioritise people with pre-frailty for medication reviews by pharmacists. The study used data from 196 community pharmacies in Belgium and included 875 community-living participants aged 70 years or older, who were using five or more medications. The final model performed reasonably well at identifying (AUC=0·75, 95% CI 0·72–0·79) pre-frail participants. Hakki Demirkapu (Vrije Universiteit Brussel, Belgium; ID 93 and ID 94) presented a pair of studies looking at advance care planning in older adults with a Moroccan or Turkish background living in Belgium. Knowledge of advance care planning was low in both populations and consideration of cultural, religious, and language barriers was important to start these conversations. Pain management was a focus of many talks with Leen Vermeulen (Médecine for the People, Belgium; ID 239) discussing a non-pharmacological approach to pain management. The multidisciplinary psychosocial group approach provides sessions in groups and aims to improve patient outcomes while providing efficiencies in care. Matteo Mannucci (semFYC, Spain; ID 376 and ID 386) provoked debate when discussing the use of opioids in palliative care. Sofia Vale (USF d’As Terras de Lanhoso, Portugal; ID 408) discussed an educational approach to review pain management in individuals and consider switches. Medical staff attended an educational session and, following this session, the amount of opioid and non-steroidal anti-inflammatory drugs prescribed during September and October, 2022, dropped compared with the same time period in 2021. However, patient outcomes were not reported.